Bon Voyage, Carlan!

Today marks, in some ways, the end of an era.  After almost two years of being together as a team, from Albertville France to Bujumbura, Banga, and Kibuye, Carlan is starting off the wave of HMAs/furloughs.  He left Kibuye this morning and will fly back to the US for three months state-side on Wednesday.  We are sad to see our energetic, hardworking, fun loving, awesome teammate and wonderful uncle to our kids say goodbye until October.  As a team, we decided it would be best to stagger our time away from Kibuye for the sake of the hospital and the sake of the medical school, but it doesn't make it easier for the rest of us to be apart.  Once Carlan returns, it's Alyssa's turn to go and then the McLaughlins and then…well, you get the picture.

So, pray for Carlan's trip back to the States, for safe travels and good times of fellowship and connection.  Pray for those of us here at Kibuye, trying not to let Carlan's newly formed ER crash and burn without him (!).  He has spent many hours in tireless service at the hospital, renovating and creating a new emergency room where there really was not one before.  We are blessed to have him as part of the McCropders, and eagerly anticipate his return.

Artemis Award

The American Academy of Ophthalmology has chosen this year's recipient of their Artemis Award, which recognizes a young ophthalmologist who has demonstrated professional caring and service to an exemplary degree.

Click here to read a great article about John!
 

On Being Rich, Part 2: New Houses and Goat Roasts

(by Eric)

The first of the McCropder families is in a permanent house.  We, the McLaughlins, moved in about 3 weeks ago, and have been loving the space and the sense of settling.  Thanks to all that have made this possible.

Celebrating my 33rd birthday in the new house.  (Yes, that is quite a couch.)

After several years of living in temporary housing (since we left our home in 2009, remember that saga?), the luxury of this nice house all to ourselves weighs on us a bit.  This is certainly added to by the poverty that is all around us.  We've written about these tensions before (and I'm sure we will again), but there is another side to that coin.

A while ago, we decided that, at the end of every major construction project (like a house) we will celebrate in traditional Kirundian fashion:  A Goat Roast.

Everyone takes the afternoon off, and all the workers get to sit down, rest, drink a Fanta, and enjoy a goat-based meal.  And, like every good African ceremony, no one can enjoy themselves unless there are several speeches made (a phenomenon inexplicable to us Americans).  So last Saturday, we hosted the first of these feasts.

Several workers getting the meal ready

Anna helping out, peeling boiled plantains

Five goats were purchased, and several crates of sodas.  The meal was rounded out by boiled and fried plantains topped with a tomatoey sauce.  Roughly 100 guys (and a few ladies) came to enjoy the food, the drinks, and the speeches.  I received a lot of applause for my line of "Nizeye ko, mu misi iza, tuzokwubaka izindi nzu, kandi tuzofungura izindi mpene nyinshi", which translates as "I hope that, in the days to come, we will build more buildings, and we will eat many more goats."

And that's kind of the point.  Not the goats, but the fact that our presence here has been employing over a hundred people steadily, some of them for close to a year now, and with the expansion projects of the hospital, I wanted to encourage them that we hope there will be steady employment for them for quite a while.

There are days that, from a development standpoint, it seems that one of the best things we do is just to live here and be (relatively) wealthy westerners.  There couldn't be a more uncomfortable role for us, but if you look, you can find signs of development.  More builders riding bikes to work instead of walking.  That guy is wearing a nice new shirt.  That other guy got glasses.  And these things weren't gifts.  It was a result of needed, viable employment, and in the process, needed buildings are built, and these guys provide for their families while increasing their skill level and work experience.  Here's the group (it's a bit hard to appreciate how many of them there are here).

So there is a lot to celebrate:  The comfort of a new home, the completion of a long process, the necessary help from a bunch of workers, and the steady employment of the equivalent of a decent sized village.  A good day.

Drummers of Burundi

by Rachel

If you are a careful observer of our blog, you'll notice that for several years now, in the upper left hand corner of our blog header picture, is an image of an African man in a toga.  It's actually one of the famous Burundian drummers.  Seriously, this is one of the main things Burundi is known for.  I've been able to watch snatches of a few performances and it is quite impressive.  Over a dozen men with large drums, singing, dancing, jumping, drumming.  A group of female dancers usually joins them at some point in the performance for cultural dancing as well.

Well, we have our own little group of lesser known but still impressive drummers here at Kibuye, the "Kibuye Primary School" drumming troupe.  Every weekday afternoon in December we heard them practicing for an upcoming competition.  Far from being wearing, it was actually quite fun to hear the drumbeat wafting across the hills.  I missed it when January started, and was excited when they started up again this month.  The practice sessions are usually composed of 10-15 kids between the ages (I would guess) of 8 and 13 drumming big kettle drums stretched with animal hides, clicking sticks, beating drums, shouting songs.  The kids like to go out to the field by the hospital and watch them practice.  Here's just a taste that I captured on my camera phone this week:

For the "official" Burundian drummers, you can watch someone else's You Tube video below.

A Glimpse Into the World of Eyes

by John & Jess Cropsey

When we moved to Kibuye in November, there was a small, unused room at the end of the hospital that was full of ancient eye equipment, worn eye charts, and assorted glasses and lenses -- remnants of an eye program that operated on a weekly basis years ago, with all those requiring surgery sent to the capital city several hours away.  Before we could start patient care, some major renovations were needed.  Until recently, it wasn't uncommon to see the odd combination of construction and medical supplies.

The operating room under construction, temporarily used as a lecture hall for the Hope Africa medical students rotating on ophthalmology.

While construction was underway, it was necessary to figure out what supplies are available in the country.  One of the ophthalmologists in Bujumbura was very helpful in connecting John with the right folks for acquiring glasses and medicine.

The display case that John built for glasses.  We have discovered that glasses are a highly desired item in Burundi and patients are eager to have them, even if they don't really need them!  

Today, the Kibuye Eye Clinic has around 80 patients each clinic day and approximately 10 operative cases each week.  

Since there was no existing eye program when we arrived, the hospital administration needed to hire new staff to work with John.  On the team, there is 1 general doctor (hoping to complete an ophthalmology residency program in the future), 2 nurses, 2 general workers, and 1 cleaner.  None of them had any experience with eye care, so they’ve had a steep learning curve over the last few months.  They are working hard (including some very long hours on clinic days) and are doing a really good job. 

The next step for the eye program is to start mobile clinics.  Since eye care (and surgical care in particular) has never been routinely available in this part of the country, there is a big need for education in basic eye care.  For example, our family recently went to visit a friend.  While we were there, Jess noticed a young neighbor boy with an eye problem (photo below -- boy in the front, far right).  John took a look and told him to come to the clinic the next day.  It turns out he had a large foreign body stuck on his eye that had been there for several months.  The mother said that she never brought him to the hospital because she thought it couldn’t be cured.  John was able to remove it from his eye and hopefully with time his cornea will completely heal.  Basic education could go a long way in decreasing the number of patients who come to the hospital too late.     

One young patient has been on our family's heart and mind the last few weeks.  His name is Butoyi and he has been diagnosed with retinoblastoma (cancer of the eye).  Treatment involves chemotherapy which is not available anywhere in the country of Burundi.  So, he and his father recently traveled to Rwanda where there is a new program for children with retinoblastoma.  The disease is advanced and he was very quiet on our journey to and from the capital city to get passports for them to leave the country.  Please pray for this young boy, his family, and the medical staff that are caring for him.  

There is still much to be done, but we are so thankful for how God is growing this work and we pray that it is a blessing to many.  

Prayercast

Our worship time at the Greece CMDA conference was headed up by a team from an organization called Prayercast.  Their purpose is to mobilize the church to pray for every nation on earth, and use media as a way to inspire and inform people to do so.  I wanted to share a few videos with you and also  let you know about their website, which is a great resource for praying for any country you can think of (like Burundi, for example!).  Of course, our internet is too slow to upload or download videos, so I'll just give the links here and encourage you to use them. :)  I believe June 8 is the national day of prayer. Please be praying for Burundi during this time, for peaceful upcoming elections in 2015, for national reconciliation, and for the gospel to penetrate all of our hearts.

Shine video:  http://prayercast.com/shine.html

Burundi video:  http://prayercast.com/burundi.html

General website: www.prayercast.com

Water Update

Six months ago, this hospital had no running water.  Handwashing was not a routine practice.  Water was carried up the hill by bucket so that surgical instruments could be washed and sterilized.  The water came from a nearby spring which provided about 40,000 L per day for the entire community, including 15 community taps, the hospital, and the hospital staff housing.  Water shortages and outages were a frequent occurrence.  

In February of last year, an Engineering Ministries International assessment team evaluated the water needs and water distribution options.  The team determined that a well the hospital had drilled was capable of pumping about 192,000 L per day, which could meet the expanding needs of the hospital campus and the surrounding community for many years.  A few months later a second team developed a master plan for the long range development of the hospital, including a plan for the water distribution system.  Some generous donors stepped up to meet the financial needs for the water system.

Earlier this year, Gaspard Ndikumana, the project leader for construction of the new water system, arranged for dozens of local men to dig the ditches, construct the well head, and lay the water pipes.

The work was done very well, and the water system now efficiently delivers plenty of water to the hospital and the surrounding area.  We thank the Engineering Ministries International team, the men who implemented the plan, and the people who donated to make it possible.

COTW: Zero Point Five

by Rachel

Miracles continue to surprise me in the world of medicine…maybe they shouldn't anymore.  Last week I received a call at 5am that a patient who had received a cesarean section in the middle of the night was having heavy bleeding and my assistance was needed.  I came up to evaluate and found out that she had been transferred to Kibuye with a dead baby and and an actively hemorrhaging placenta previa (a problem where the placenta covers the cervix and a normal delivery is impossible and potentially fatal for mom and baby).  One of my colleagues had done a C-section for her in the middle of the night and he told me that there had been "a lot of bleeding" but by the end of the surgery the bleeding had stopped.  Now she was having a lot of vaginal bleeding, not necessarily signs of bleeding into her abdomen.  I've seen several cases where patients have a hemorrhage after a previa because the site where the placenta had attached to the uterus continues to bleed.  The uterine muscle is located mainly at the top of the uterus and can't "clamp down" as well near the cervix to stop this kind of bleeding.  I put several catheters into her uterus to compress the bleeding site and asked the nurses to check her hemoglobin.

An hour or so later, while I was sitting in the middle of teaching rounds with nursing and medical students, the nurse came in and handed me the results.  It took a few looks for the result to sink in.  Her hemoglobin, a measure of how much blood (and therefore oxygen carrying capacity) remains in the body, was 0.5.  I have NEVER seen such a number.  Normal is 12-16.  Most people are dead if they lose this much blood.  Less than 4-6 is an emergency, even in our setting.

The complications began.  It was obvious the patient needed blood.  RIGHT NOW.  She was virtually comatose and still having some vaginal bleeding.  Our blood bank was empty.  We called Gitega, the nearest bigger hospital (30 min away) about transferring the patient for a transfusion and better management.  They had blood available, but were out of the reagent to test for hepatitis on the blood, so they would not release the blood to anyone.  Many phone calls and much discussion ensued.  It was decided we could send the patient and the hepatitis reagent to Gitega, so they could check the blood and give it to her.  Excellent.  One more problem, though.  The ambulance (our only means of transporting her) was out of gas.  What?

Another series of phone calls and discussions ensued.  There was more gas, but no one had the key to the room where the gas was kept.  The man with the key was "not here." (in classic African fashion)  I pulled out my hair.  I thought about kicking the wall.  I resorted to (what should have been my first thought) prayer.  The patient kept breathing.  The man with the key showed up.  The ambulance left for Gitega.  I breathed a sigh of relief.  We got a call from Gitega that they would not accept the patient because she didn't have the $12 needed for a transfusion.  Someone made some other calls to higher ups.  Nine hours after my first 5am call, my nurse found me.  The patient was still alive.  She had gotten one unit of blood and was now being sent back to us.  WHAT?!  She needed at least 4-5 units!

Fortunately, Gitega did send a few more units of blood back with her, so we kept on transfusing.  She woke up and stopped bleeding and when I saw her on the second day after her surgery, she was sitting up and smiling.  I sent her home yesterday.  Miracle.

At Our Hospital…

(from Eric)

At our hospital, there are a lot of bare feet.  There are also a lot of open-toed shoes worn by medical professionals.  Lastly, there are special close-toed shoes you can put on if you are going into the operating room.

At our hospital, there are sometimes goats.  Not big ones usually, but little black goats, inside the hospital grounds, skipping in between the buildings.  Someone is usually following them, to get them out.  But they are there nonetheless.

At our hospital, there is no parking lot.  This is because there are remarkably few cars.  Most people arrive at the hospital by walking.  If they cannot walk, they will sit on a bicycle, while their family pushes it, or maybe be carried in a hand-made litter with poles.

At our hospital, jeans are “dress clothes,” because they are fancy, I guess.  I’m not arguing.

At our hospital, the nurses will sit outside the pediatrics ward to work on putting a new IV in a child, because it’s simply not well-lit enough inside.

At our hospital, we needed to check a lady for protein in the urine, but we had run out of test strips in the lab.  Then we remembered that another patient of ours had bought some test strips for his diabetes (from a nearby town), and those strips checked both sugar and protein in the urine.  So our diagnostic plan for the day was to ask the second patient if he wouldn’t mind giving one of his strips to the first patient to check for protein.  He didn’t mind at all.

At our hospital, there are not many shops in the neighborhood, but you can buy scratch cards to add minutes to your mobile phone.  The story is that, a while ago, a certain woman was brought to the hospital paralyzed and then abandoned by her family.  In the face of this difficult situation, the hospital eventually decided to give her one of the private patient rooms, which is where she now lives, invariably in good spirits, earning her living by selling mobile phone minutes, 30 cents at a time, for honestly a pretty steep rate, but hey, she’s got a corner on the market.

Pretty much all of these distinctives are the result, directly or indirectly, or poverty or scarcity, and our attempts to live life in the face of it.  And there are disadvantages to each of them (e.g. there are reasons why US hospitals required closed-toe shoes), and if all goes well, I imagine some of these things will change.  

However, there is a humanizing informality about all these things, as well.  There is a redemption in the response to the scarcity that creates a home-ness, a sense of “our hospital.”

Greece

by Rachel

One of the challenges of living overseas and working in the health professions is keeping up our professional credentials.  As you have likely heard, over the past few years at least half of the docs on the team have flown back to the States to take Board exams, certifying us to practice medicine within our specialities in the US.  Even though we may or may not work in the US in years to come, keeping up credentials is important (and expensive), but keeps many doors open for us.  Every doctor is responsible for taking a certain number of credits of Continuing Medical Education each year.  Usually these requirements can be fulfilled by attending seminars, lectures, and conferences close to home.  But last we checked, Burundi doesn’t offer any CME...

Fortunately for us the Christian Medical/Dental Association offers a yearly international conference of CME for medical missionaries working abroad.  Every other year it’s held in Kenya (Thailand on the off years) but this year it was moved to Greece due to space constraints.  Alyssa and the McLaughlins were able to go for two weeks at the end of April and it was great!  The first few days were especially important, as Alyssa and Rachel got extra training in how to teach management of neonatal resuscitation and obstetrical emergencies, and all three of us received hands-on instruction on a variety of ultrasound (cardiac echos, abdominal, diagnosing DVTs, etc).  We got to attend lots of lectures on topics from tropical disease to updates in US medicine to community health and personal care.  We also had daily worship and sermons (in English!) for spiritual growth.  And then of course the highlight was visiting and catching up with friends from all over the globe--the world of medical missions is very small!  There were actually over 700 people from 70 different countries attending.  We caught up with friends from Tenwek, World Harvest/Serge, Loma Linda med school, former missionaries to Burundi, and even the couple who are currently living in our old apartment in Albertville, France!

Fellow Serge (WHM) medical missionaries

Shirley, a nurse in Kenya, worked at Kibuye for several years in the 1980s.  Monica works with an NGO called LifeNet in Bujumbura.

Loma Linda University classmates!

At the end of the conference, we took a few days to see Athens and experience Greece, a much needed vacation.  Eric’s parents came to help out with the kids and visit, which was a special time as well.  Thanks to everyone who helped make this possible for us!